Webber, Elaine DNP, PNP-BC, and Janice MSNc Cecil
Perinatal transmission of Human Immunodeficiency Virus (HIV) is the most common route of HIV transmission in children. Infection can occur late in the pregnancy, during delivery or through breastfeeding. Between 120,000 to 160,000 women of childbearing age in the US are infected with HIV; nearly one out of four of these women are unaware of their HIV status. Many cases of perinatal HIV infection involve women who were not tested early enough in pregnancy or who did not receive prevention services.
A community hospital's Maternal Child Health department experienced a missed opportunity regarding an HIV positive patient presenting with incomplete prenatal records. Only after the infant showed signs of illness, high risk obstetrical labs were ordered, resulting in a preliminary maternal positive HIV test. Despite unconfirmed maternal HIV status, chart notes indicate the infant was breastfed during the postpartum period which increases the risk of disease transmission to the infant. This event exposed gaps in the department’s management of high risk obstetrical patients. To address these gaps a multi-disciplinary task force was convened to develop a comprehensive HIV management plan. Working with the Michigan Department of Community Health to ensure the plan incorporated state recommendations and statutory requirements, the new plan included:
Over a one month period, all nurses and physicians in the MCH department and OB clinics underwent in-servicing regarding the new policy, HIV testing and documentation. Following program implementation, the multidisciplinary team, in conjunction with the hospital Quality Improvement Department devised an audit tool to evaluate compliance with the protocol. Chart reviews indicated 100% compliance with HIV testing at the first obstetrical visit and upon admission to Labor and Delivery. During the same review period, compliance with required HIV testing at 26-28 weeks gestation at hospital owned obstetrical practices ranged from 66% - 100%. To maintain high compliance with the protocol as well as address areas of lower compliance, ongoing education regarding HIV testing, treatment and documentation is now included in the department’s mandatory education program for all nursing and physician staff. Outreach to OB clinic staff has been implemented to improve compliance with HIV testing at 26-28 weeks gestation.
The goals of the 2010 National HIV/AIDS Strategy are to reduce the number of people who become infected with HIV, increase access to care, and reduce HIV related health disparities. The 2007 CDC report indicated 100-200 infants in the US were infected with HIV annually. Given that the most common route of HIV transmission in children is through the mother, it is imperative that health care institutions comply with MDCH guidelines and institute a comprehensive plan for testing and treatment of all pregnant women.